Individual
DR. JOSE SANTIAGO SUBAUSTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1500 E WOODROW WILSON AVE, R&E BUILDING (151) - VAMC, JACKSON, MS 39216-5116
(601) 362-4471
(601) 364-1390
Mailing address
1500 E WOODROW WILSON AVE, R&E BUILDING (151) - VAMC, JACKSON, MS 39216-5116
(601) 362-4471
(601) 364-1390
Taxonomy
Speciality
Code
Description
License number
State
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
16940
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00122769
—
MS
01
—
512I110033
PTAN
MS
Enumeration date
07/09/2006
Last updated
06/15/2012
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